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Resources to Drive Performance and Profitability:

MA plans contract with only a select number of post-acute care providers. In order to win these MA contracts, post-acute care providers need to prove their value. They need to convince MA plans that they have lower costs and good patient outcomes.

  1. MA plans contract with only a select number of post-acute care providers. In order to win these MA contracts, post-acute care providers need to prove their value. They need to convince MA plans that they have lower costs and good patient outcomes.
  2. Second, MA plans have contracts with post-acute care providers that typically pay less then Medicare FFS rates, pay differently (e.g., per stay rather than per day), or require post-acute care providers to take on some financial risks. Such arrangements provide incentives to post-acute providers to discharge patients early to their homes or to a lower cost post-acute care setting.
  3. Third, MA plans use other managed care tools such as prior authorization to limit use of higher cost post-acute care providers. Plans also might impose higher cost-sharing for post-acute care services to incentivize patients to limit their use.
  4. Last but not the least, MA plans use data-driven insights combined with better patient and provider engagement to manage care transitions from acute to post-acute care and to coordinate care across settings. A variety of organizations and consultants help MA plans achieve these goals.

Medicare Advantage plans are looking for providers that can deliver high-quality care, partner on member satisfaction value, provide data driven value, and can reduce the cost of care.

Medicare Advantage plans are looking for providers that can deliver high-quality care, partner on member satisfaction value, provide data driven value, and can reduce the cost of care.

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